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Nonprofiteer
← ST JOSEPH AMBULATORY CARE INC

Form 990 for tax year 2024

Filed by ST JOSEPH AMBULATORY CARE INC.

Totals

Total revenue
$1,632,428
Total expenses
$1,849,186
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$1,632,428
Investment income
$0
Other revenue
$0
Total assets, end of year
$322,046
Total liabilities, end of year
$3,618,171
Net assets or fund balances, end of year
-$3,296,125
Program services expenses (Part IX)
$1,771,380
Management and general expenses
$77,806
Fundraising expenses
$0
Program service expenses (Part III)
$1,771,380

Program services were 95.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: Occupational health

    total $1,073,927 · related or exempt $1,073,927

  • 2b · Program service revenue: Clinical care

    total $542,527 · related or exempt $542,527

  • 2c · Program service revenue: Patient service

    total $15,974 · related or exempt $15,974

Functional expenses

Part IX, the statement of functional expenses.

  • 7 · Other salaries and wages

    total $1,304,522 · program services $1,252,341 · management and general $52,181

  • 8 · Pension plan contributions

    total $18,004 · program services $17,464 · management and general $540

  • 9 · Other employee benefits

    total $90,307 · program services $87,598 · management and general $2,709

  • 10 · Payroll taxes

    total $84,515 · program services $81,980 · management and general $2,535

  • 11g · Fees: other

    total $176,159 · program services $163,828 · management and general $12,331

  • 13 · Office expenses

    total $9,939 · program services $9,243 · management and general $696

  • 16 · Occupancy

    total $91,212 · program services $84,827 · management and general $6,385

  • 17 · Travel

    total $1,320 · program services $1,228 · management and general $92

  • 19 · Conferences, conventions and meetings

    total $4,812 · program services $4,475 · management and general $337

  • 22 · Depreciation, depletion and amortization

    total $3,440 · program services $3,440

  • 24a · Other expenses: Drugs/medical supplies

    total $63,652 · program services $63,652

  • 24b · Other expenses: Minor equipment

    total $697 · program services $697

  • 24c · Other expenses: Food and nutrition

    total $607 · program services $607

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $19,551 · end of year $25,632

  • 4 · Accounts receivable

    beginning of year $110,972 · end of year $204,774

  • 9 · Prepaid expenses and deferred charges

    beginning of year $449 · end of year $449

  • 10a · Land, buildings and equipment: cost or other basis

    $759,288

  • 10b · Land, buildings and equipment: accumulated depreciation

    $742,366

  • 10c · Land, buildings and equipment, net

    beginning of year $20,362 · end of year $16,922

  • 15 · Other assets

    beginning of year $0 · end of year $74,269

  • 17 · Accounts payable and accrued expenses

    beginning of year $89,577 · end of year $101,058

  • 25 · Other liabilities

    beginning of year $3,141,124 · end of year $3,517,113

  • 27 · Net assets without donor restrictions

    beginning of year -$3,079,367 · end of year -$3,296,125

Mission and programs · 2024

Mission

Employee safety and health services

  • St. Joseph's Ambulatory Care, Inc. provides employee safety and health services.

    Expenses $1,771,380 · Revenue $1,632,428

As filed on the 2024 return.

Listed in Part VII

  • Stephen Grubbs

    Trustee; CEO of Covenant Health

    Total calculated
    $1,276,101
    From this org
    $0
    From related orgs
    $1,235,937
    Other
    $40,164
    Hours/week
    0.1 + 40.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $805,455 related
    Bonus
    $0 + $400,000 related
    Other
    $0 + $30,482 related
    Deferred
    $0 + $10,350 related
    Nontaxable benefits
    $0 + $29,814 related
    Filer's total
    $0 + $1,276,101 related

  • Jims Jean Jacques MD

    Physician

    Total calculated
    $624,458
    From this org
    $0
    From related orgs
    $580,804
    Other
    $43,654
    Hours/week
    0.1 + 40.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $579,448 related
    Bonus
    $0
    Other
    $0 + $1,356 related
    Deferred
    $0 + $6,783 related
    Nontaxable benefits
    $0 + $36,871 related
    Filer's total
    $0 + $624,458 related

  • Joanmarie Pellegrini MD

    Trustee/Physician (Start 1/2024)

    Total calculated
    $355,517
    From this org
    $0
    From related orgs
    $323,732
    Other
    $31,785
    Hours/week
    0.1 + 40.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $298,505 related
    Bonus
    $0
    Other
    $0 + $25,227 related
    Deferred
    $0 + $5,075 related
    Nontaxable benefits
    $0 + $26,710 related
    Filer's total
    $0 + $355,517 related

  • William Wood MD

    Trustee

    Total calculated
    $30,392
    From this org
    $0
    From related orgs
    $30,392
    Other
    $0
    Hours/week
    0.1 + 0.4 related

  • William Buckley

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Anita Haskell

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Rosalind Prince Gilman Esq

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Curtis Kimball Esq

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Judith Josiah Martin

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Bradley Ryder

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Lori Varney

    Trustee

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Robert Clark

    Chairman

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Rebecca Cyr Whitmore

    Vice Chairman

    Total calculated
    $0
    Hours/week
    0.1 + 0.4 related

  • Mary Prybylo

    President & CEO, Trustee Ex-Officio

    Total calculated
    $575,948
    From this org
    $0
    From related orgs
    $536,374
    Other
    $39,574
    Hours/week
    0.1 + 40.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $403,833 related
    Bonus
    $0 + $122,823 related
    Other
    $0 + $9,718 related
    Deferred
    $0 + $10,350 related
    Nontaxable benefits
    $0 + $29,224 related
    Filer's total
    $0 + $575,948 related

  • Michael Hendrix

    Treasurer/VP Finance

    Total calculated
    $411,023
    From this org
    $0
    From related orgs
    $365,231
    Other
    $45,792
    Hours/week
    0.1 + 40.4 related

    Schedule J breakdown matched by us

    Base
    $0 + $363,124 related
    Bonus
    $0
    Other
    $0 + $2,107 related
    Deferred
    $0 + $8,774 related
    Nontaxable benefits
    $0 + $37,018 related
    Filer's total
    $0 + $411,023 related

  • Donna Berry

    Secretary

    Total calculated
    $120,688
    From this org
    $0
    From related orgs
    $91,683
    Other
    $29,005
    Hours/week
    0.1 + 40.4 related

  • Poonam Khadka MD

    Physician

    Total calculated
    $285,324
    From this org
    $270,365
    From related orgs
    $0
    Other
    $14,959
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $246,991
    Bonus
    $0
    Other
    $23,374
    Deferred
    $3,765
    Nontaxable benefits
    $11,194
    Filer's total
    $285,324

  • Sanjay Pandey MD

    Physician

    Total calculated
    $283,491
    From this org
    $251,944
    From related orgs
    $0
    Other
    $31,547
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $228,375
    Bonus
    $0
    Other
    $23,569
    Deferred
    $4,766
    Nontaxable benefits
    $26,781
    Filer's total
    $283,491

  • Jamie Perry

    Nurse Practioner

    Total calculated
    $188,705
    From this org
    $182,543
    From related orgs
    $0
    Other
    $6,162
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $182,366
    Bonus
    $0
    Other
    $177
    Deferred
    $5,421
    Nontaxable benefits
    $741
    Filer's total
    $188,705

  • Marcella Kenny

    Occupational Nure

    Total calculated
    $122,416
    From this org
    $100,350
    From related orgs
    $0
    Other
    $22,066
    Hours/week
    40

  • Lauren Jellison

    Nurse Practioner

    Total calculated
    $105,096
    From this org
    $100,832
    From related orgs
    $0
    Other
    $4,264
    Hours/week
    40

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

None.

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Part I, Line 3
Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • Campus Holding

    C · Holding company · ME

  • Covenant Health Insurance LTD

    C · Self-insurance company · CJ

  • GNM Corporation

    C · Real estate holding company · NH

  • SJ Physicians Services

    C · Physician practice · NH

  • St Joseph Corporate Services Inc

    C · Holding company · NH

  • Strauss Incorporated

    C · Repairs and transcriptions · ME

Provenance

Return type
form_990
Tax year
2024
Filed
3 November 2025
IRS schema version
2024v5.2
Source object
202513189349310291

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